Unintentional obstructed airway injuries are the fourth leading cause of unintentional home injury death in the United States and result in an average of 1,092 fatalities each year. [1] There are three types of obstructed airway injuries: suffocation is obstruction of the nose and mouth from an external object such as a plastic bag; choking is blocking the airway internally, usually by food or small toys in young children; strangulation is external compression of the airway from an object, such as a string around the neck. [2] Children under age 5 are at greatest risk of obstructed airway injuries because of their small airway, inexperience with chewing, and tendency to put objects in the mouth. [1, 3] Most of the prevention strategies for obstructed airway injuries have been focused on product regulation. Federal regulation of cribs, toys and other articles intended for use by children under 3 years has made significant progress in reducing the incidence of choking, strangulation and suffocation. [2]

Morbidity and mortality

Deaths

Unintentional choking and suffocation is the leading cause of all injury death for infants under the age of 1 and the eighth leading cause of injury death for all ages. [4]

In 2002 over 5,500 people died from unintentional choking or suffocation of which 636 were under the age of 1. [4]

In 2001, 864 children ages 14 and under died from unintentional airway obstruction injuries. Of these children, 87% were ages 4 and under. [3]

During 2000, 160 children aged 14 years died from obstruction of the respiratory tract with foreign bodies; food and nonfood substances were associated with 41% and 59% of these deaths, respectively. [5]

Injuries and Emergency Room Visits

For every choking-related death, there are more than 100 visits to U.S. emergency departments. [6]

More than 36,000 obstructed airway injuries in the home result in emergency room visits each year. [1]

Sixty percent of nonfatal choking episodes treated in emergency departments are associated with food items; 31% with nonfood objects including coins; in 9% of the episodes the substance is unknown. [6]

In 2001, an estimated 17,537 children under age 15 were treated in U.S. emergency rooms for choking episodes, most of whom were ages 4 and under. [3, 6]

Candy is associated with 19% of choking-related emergency room visits by children under age 15; 65% are from hard candy; 12.5% are from other specified types (chocolates, gummy bears, etc.). [6]

Where, when, and how the deaths and injuries occur

Suffocation

Sixty percent of infant suffocation occurs in beds/cribs. Infants suffocate when their faces become buried in a mattress, pillow or other soft bedding or when someone in the same bed rolls onto them. [3]

Playpens with soft bedding or improper or extra mattresses, cribs (primarily older, used cribs) and play yards are also responsible for many infant suffocation deaths each year. [3]

Choking

The majority of childhood choking injuries are associated with food items. Children are at risk from choking on small, round foods such as hot dogs, candies, nuts, grapes, carrots, and popcorn. [3, 7]

NonÂ­food choking hazards tend to be round or pliable objects such as coins, small balls, marbles, jewelry, and balloons. Of toys, balloons are the leading cause of choking. [2, 3]

Strangulation

Strangulation occurs among children when consumer products become wrapped around their necks. Common items include clothing drawstrings, ribbons or other decorations, necklaces, pacifier strings, and window blinds and drapery cords. [3]

Children also strangle in openings that permit the passage of their bodies, yet are too small for, and entrap, their heads. These include spaces in bunk beds, cribs, playground equipment, baby strollers, carriages, and high chairs. [3]

Populations at disproportionate risk

Children ages 4 and under, especially under age 1, are at greatest risk for all airway obstruction injuries. Their disproportionate risk is due to small upper airways, inexperience with chewing, a developmental tendency to put objects in the mouth, and inability to distinguish food from nonÂ­food items. [1, 3]

Male, low-income and nonwhite children are at increased risk from obstructed airway injuries. [3]

Children placed in adult beds are at increased risk for airway obstruction injury. [3]

Adults 70 and older are also at increased risk of death from choking and suffocation. [1]

Across all age groups, males have higher death rates from choking and suffocation than females. [1]

Effectiveness of injury interventions

The Child Safety Protection Act bans toys intended for children under age 3 that pose an obstructed airway hazard, and requires warning labels for items with small parts when intended for children ages 3 to 6. [2, 3]

Despite increased toy labeling, some parents may not understand the intention of labels. In a study of 199 toy buyers, 44% said they would buy a toy for a child age 2 to 3 years if it was labeled "Recommended for 3 and up", but only 5% would buy it if it was labeled "Not recommended for below 3-small parts". [2]

The US Consumer Product Safety Commission has issued voluntary guidelines of children's outerwear garments (jackets and sweatshirts) with drawstrings in the neck and waistband. They also issued a mandatory standard for bunk beds to restrict opening size and reduce entrapment hazards. [2, 3]

Cost and cost-effectiveness data

Unintentional suffocation injuries cost the country an average of $3 billion annually in medical care. [1]

References

1. Runyan, C. and C. Casteel, eds. The State of Home Safety in America: Facts About Unintentional Injuries in the Home. 2nd ed. 2004, Home Safety Council: Washington, DC.